HIV Testing Day: Bringing viral load assessment to primary care

Abbott has developed a blood test that can measure the viral load of an individual HIV patient in under 70 minutes. This technology has the potential to give people living with the disease greater freedom in managing their condition and expand HIV care in resource-poor settings.

People living with HIV are advised by healthcare organisations the world over to undergo antiretroviral therapy (ART). ART supresses the HIV virus and prevents progression of the disease, taking HIV from a death sentence to a permanent but manageable condition.

An HIV patient on ART eventually has the viral load of HIV in their body reduced to what is clinically referred to as ‘undetectable’ levels. This means that there is such a low level of HIV in their blood that the virus cannot be detected by standard blood tests. A person with an undetectable viral load cannot pass on HIV to someone else.

Simply taking ART does not automatically mean the patient’s viral load is undetectable and it’s very common for levels to fluctuate, particularly when they have only just begun treatment. The World Health Organisation (WHO) therefore recommends that people on ART undergo a viral load test twice in the year after they start treatment and annually after that.

This testing regimen is designed to monitor patient adherence to medication and minimise treatment failure, but many developing countries in sub-Saharan Africa, Asia and Latin America lack the resources to provide widespread access to this kind of testing.

How can this lack of resources be managed?

A new assay developed by Abbott, known as m-PIMA™ HIV-1/2 VL (m-PIMA), has been designed to provide healthcare professionals – particularly those in remote and resource-poor communities – with a fast, accurate and easy-to-use way to help manage their patients’ HIV.

In a statement, Abbott infectious disease vice president Damian Halloran said: “m-PIMA HIV-1/2 VL is the only truly portable molecular point-of-care test designed specifically for use in resource-limited settings such as in sub-Saharan Africa.”

m-PIMA uses quantitative nucleic acid amplification to measure the viral load of multiple types of HIV virus in plasma samples. It does so in 70 minutes or less, meaning a patient can have their test results and any necessary adjustments to their treatment organised within the same appointment.

This is hugely beneficial for patients who may need to travel long distances to their nearest clinic, in areas where it is hard to send samples away for laboratory testing and harder still to swiftly contact patients about their results.

The m-PIMA assay received WHO prequalification, a standard used by the UN and other organisations to make purchasing decisions, in May 2019, and received the European CE mark in December 2018. It’s a technology that has been welcomed by charities who work with HIV and AIDS patients.

National AIDS Trust director of strategy Yusef Azad says: “Improvements in the portability and speed of results of HIV viral load testing offer real benefits in countries where access to viral load testing is limited, which is far from ideal for treatment purposes. Even in resource-rich settings such as the UK, expanding options and choice for viral load testing allows us to think about routine care for people with HIV taking place in a variety of settings to better suit patients.”

HIV testing has come a long way in developed nations too

London’s 56 Dean Street sexual health clinic was the first in the UK to use Cepheid’s GeneXpert Infinity machine to test blood samples for the presence of HIV. Patients are texted their results within six hours of their initial donation.

The Infinity machine operates on-site in the clinic, avoiding the rigmarole of laboratory testing, and allows all results to be received within six hours of donation. The system can test between 16 to 80 samples at a time, and can be used to test for the presence and viral load of HIV.

While m-PIMA is perfect for patients who need on-the-spot results in remote clinics with limited resources and lower footfall, the Infinity machine is optimised for a busy inner-city clinic which sees hundreds of patients every day. Treatment and care needs differ drastically based on geography, and the m-PIMA and Infinity machines highlight a crucial difference between the testing needs of HIV patients across the world.

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The French company Ionisos is one of the first companies in the world to have put ionising rays to good use for the sterilisation of medical devices. Originally known as Conservatome (from 1958 to 1993), Ionisos came into being in 1993 following a merger between Conservatome and Amphytrion. Ionisos now offers cold sterilisation for a range of applications.